Safety and Diagnostic Accuracy of Biopsy of Targeted Splenic Lesions Under Ultrasound Guidance Using the Multiple-Pass Technique Without Co-Axial in Kinshasa Hospitals
Introduction: The most frequent splenic pathologies can pose a diagnostic challenge to clinicians, radiologists and pathologists. These pathologies are innumerable, and may be of malignant or benign tumoral origin. Six techniques are currently available to obtain splenic tissue samples for pathological evaluation. Less invasive percutaneous techniques, performed by an interventional radiologist under ultrasound or CT guidance, include fine-needle aspiration biopsy and core tissue biopsy. They are associated with fewer complications and greater precision. Materials and Methods: This was a descriptive, multicenter, observational study of the various radioguided percutaneous splenic puncture-biopsy procedures performed using the multiple-pass technique without co-axial placement over a 5-year period. The objectives of the present study were to demonstrate the safety and diagnostic accuracy of targeted splenic puncture biopsy using the multiple-pass technique without co-axial placement, and to evaluate the rate of major complications of the said technique. Results: A total of eighteen patients underwent percutaneous splenic biopsy. In this study, patients aged ≤ 25 years (33.3%) and those aged 48-58 and 59-69 years were more likely to have undergone percutaneous splenic biopsy. (22.2% and 22.2%) were the most affected. Males predominated, with 66.7% versus 33.3%. Splenomegaly was the most frequently encountered clinical parameter with 44.44%. Lymphomatous lesions were present in 33.3% of patients, with CD20-negative diffuse large-cell lymphoma (11.1%), non-Hodgkin’s lymphoma (11.2%) and hepatosplenic T lymphoma NOS (11.1%). Splenic tuberculosis ranked second in 22.2% of patients, and Gauchier’s disease in 22.2%. Ultrasound was the most commonly used radiological guide in 88.9% of cases. The 14-gauge automatic gun was used in 44.4% of cases. The co-axial or indirect technique was used in all patients (100%); the multiple-pass technique without co-axial (T-MPSC) was used in all patients (100%); 4-5 cores were taken in the majority of patients (88.9%). No major complications were encountered in the present series. Conclusion: Radiation-guided percutaneous biopsy of splenic lesions with automatic or semi-automatic 14-16 G tru-cuts, using the coaxial-free multiple-pass technique (T-MPSC), yields large-calibre tissue material for accurate diagnosis during pathological analysis. This technique also avoids embolization of the co-axial pathway and per- or post-biosurgical haemorrhagic complications. In conclusion, percutaneous radio-guided splenic biopsy is an effective alternative to splenectomy in patients with single or multiple splenic lesions.
